Complications of Coronary Artery Bypass Grafting

Document Type: Narrative Review

Authors

Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK

Abstract

Coronary artery bypass grafting (CABG) has become much safer over the last 50 years due to advancement in clinical practice and technology development. However, it is still a complex and high-risk operation that carries significant morbidities and mortality. The most serious adverse events are death, stroke, bleeding requiring further surgery, peri-operative myocardial infarction, cardiac arrhythmias, and deep sternal wound infection. Each complication has an approximate risk of 1%-2%, and they must be fully discussed with the patient during the consent process. Many other complications can occur as the procedure affects the entire circulatory system and the visceral organs. Advancements have been made in cardiopulmonary bypass, graft selection, operating room practices, and multi-disciplinary team-working to reduce the risk of such complications occurring. This review article focused on the key complications of CABG.

Keywords


  1. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018;10(3):1960- 1967. doi:10.21037/jtd.2018.02.43.
  2. Selim M. Perioperative stroke. N Engl J Med. 2007;356(7):706- 713. doi:10.1056/NEJMra062668.
  3. McKhann GM, Goldsborough MA, Borowicz LM Jr, et al. Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg. 1997;63(2):516-521. doi:10.1016/S0003-4975(97)83384-X.
  4. Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996;335(25):1857-1863. doi:10.1056/NEJM199612193352501.
  5. Noyez L, Kievit PC, van Swieten HA, de Boer MJ. Cardiac operative risk evaluation: The EuroSCORE II, does it make a real difference? Neth Heart J. 2012;20(12):494-498. doi:10.1007/s12471-012-0327-1.
  6. Larobina ME, Merry CJ, Negri JC, Pick AW. Is informed consent in cardiac surgery and percutaneous coronary intervention achievable? ANZ J Surg. 2007;77(7):530-534. doi:10.1111/j.1445-2197.2007.04143.x.
  7. Alexander JH, Ferguson TB Jr, Joseph DM, et al. The PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial: study rationale, design, and baseline patient characteristics. Am Heart J. 2005;150(4):643-649. doi:10.1016/j.ahj.2005.05.021.
  8. Rudolph JL, Inouye SK, Jones RN, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58(4):643-649. doi:10.1111/j.1532-5415.2010.02762.x.
  9. Ho PM, Arciniegas DB, Grigsby J, et al. Predictors of cognitive decline following coronary artery bypass graft surgery. Ann Thorac Surg. 2004;77(2):597-603; discussion 603. doi:10.1016/S0003-4975(03)01358-4.
  10. Braxton JH, Marrin CA, McGrath PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg. 2004;16(1):70-76. doi:10.1053/j.semtcvs.2004.01.006.
  11. Banbury MK, Brizzio ME, Rajeswaran J, Lytle BW, Blackstone EH. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg. 2006;202(1):131-138. doi:10.1016/j.jamcollsurg.2005.08.028.
  12. van de Watering LM, Hermans J, Houbiers JG, et al. Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial. Circulation. 1998;97(6):562-568. doi:10.1161/01.CIR.97.6.562.
  13. Abraham VS, Swain JA. Cardiopulmonary bypass and kidney. In: Gravlee GP, Davis RF, eds. Cardiopulmonary bypass: principles and practice. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2000:382-391.
  14. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998;128(3):194-203. doi:10.7326/0003-4819-128-3-199802010-00005.
  15. Mariscalco G, Klersy C, Zanobini M, et al. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008;118(16):1612-1618. doi:10.1161/CIRCULATIONAHA.108.777789.
  16. Naveed A, Azam H, Murtaza HG, Ahmad RA, Baig MAR. Incidence and risk factors of Pulmonary Complications after Cardiopulmonary bypass. Pak J Med Sci. 2017;33(4):993-996. doi:10.12669/pjms.334.12846.
  17. Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol. 2014;46(2):142-149.
  18. Eris C, Yavuz S, Yalcinkaya S, et al. Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients. ScientificWorldJournal. 2013;2013:631534. doi:10.1155/2013/631534.
  19. Passaroni AC, Silva MA, Yoshida WB. Cardiopulmonary bypass: development of John Gibbon’s heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-245. doi:10.5935/1678- 9741.20150021.
  20. Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017;61(9):760-767. doi:10.4103/ija.IJA_379_17.
  21. Landis RC, Brown JR, Fitzgerald D, et al. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base. J Extra Corpor Technol. 2014;46(3):197-211.
  22. Rong LQ, Di Franco A, Gaudino M. Acute respiratory distress syndrome after cardiac surgery. J Thorac Dis. 2016;8(10):E1177-e1186. doi:10.21037/jtd.2016.10.74.
  23. Hossne Junior NA, Miranda M, Monteiro MR, et al. Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure. Rev Bras Cir Cardiovasc. 2015;30(4):482-488. doi:10.5935/1678-9741.20140092.
  24. Vercaemst L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: a review in search of a treatment algorithm. J Extra Corpor Technol. 2008;40(4):257-267.
  25. Finley A, Greenberg C. Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass. Anesth Analg. 2013;116(6):1210-1222. doi:10.1213/ANE.0b013e31827e4e62.
  26. Hogue CW, Gottesman RF, Stearns J. Mechanisms of cerebral injury from cardiac surgery. Crit Care Clin. 2008;24(1):83-98, viii-ix. doi:10.1016/j.ccc.2007.09.004.
  27. Buffolo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61(1):63-66. doi:10.1016/0003-4975(95)00840-3.
  28. Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials. Eur Heart J. 2012;33(10):1257-1267. doi:10.1093/eurheartj/ehr307.
  29. Forouzannia SK, Abdollahi MH, Mirhosseini SJ, et al. Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery. Acta Med Iran. 2011;49(7):414-419.
  30. Yadava OP, Prakash A, Kundu A, Yadava M. Coronary artery bypass grafting in women--is OPCAB mandatory? Indian Heart J. 2011;63(5):425-428.
  31. Shroyer AL, Grover FL, Hattler B, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19):1827- 1837. doi:10.1056/NEJMoa0902905.
  32. Bourassa MG, Fisher LD, Campeau L, Gillespie MJ, McConney M, Lesperance J. Long-term fate of bypass grafts: the Coronary Artery Surgery Study (CASS) and Montreal Heart Institute experiences. Circulation. 1985;72(6 Pt 2):V71-78.
  33. Harky A, Balmforth D, Shipolini A, Uppal R. Is endoscopic long saphenous vein harvesting equivalent to open harvesting technique in terms of graft patency? Interact Cardiovasc Thorac Surg. 2017;25(2):323-326. doi:10.1093/icvts/ivx049.
  34. Fiore AC, Naunheim KS, Dean P, et al. Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg. 1990;49(2):202-208; discussion 208-209. doi:10.1016/0003-4975(90)90139-W.
  35. Athanasiou T, Saso S, Rao C, et al. Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition--which conduit offers better patency? A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2011;40(1):208- 220. doi:10.1016/j.ejcts.2010.11.012.
  36. Glineur D, D’Hoore W, El Khoury G, et al. Angiographic predictors of 6-month patency of bypass grafts implanted to the right coronary artery a prospective randomized comparison of gastroepiploic artery and saphenous vein grafts. J Am Coll Cardiol. 2008;51(2):120-125. doi:10.1016/j.jacc.2007.09.030.
  37. Buche M, Schroeder E, Gurne O, et al. Coronary artery bypass grafting with the inferior epigastric artery. Midterm clinical and angiographic results. J Thorac Cardiovasc Surg. 1995;109(3):553- 559; discussion 559-560. doi:10.1016/S0022-5223(95)70288-1.